Physical Exam Key Points

1. Vital signs. Hypertension may be present.

2. Skin. Observe for reddish-purple, indurated areas over pressure points, with subcutaneous fat necrosis; pruritus with skin calcifications.

3. Lymph nodes. Sign of malignancy or granulomatous disorder.

4. HEENT. Elfin-like facies in infants points to Williams syndrome.

5. Heart. Murmur of supravalvular aortic stenosis is characteristic of Williams syndrome.

6. Neuromuscular. Impaired mentation, muscle weakness, and hyporeflexia.

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